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peds special pops > peds gi disorders 1 test 2 > Flashcards

peds gi disorders 1 test 2 Flashcards

1
Q

(Hypertrophic) Pyloric stenosis causes

A

Incomplete maturation of nerve fibers to pylorus

Mechanical trauma from stomach contents resulting in pyloric muscle hypertrophy

Develops after birth
Associated with some genetic syndromes: Apert, Zellweger, trisomy 18

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2
Q

t/f Females with pyloric stenosis have a 4x greater chance of having a child with the disease

A

true (this was one of the first questions I asked my wife. I aint got time for that)

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3
Q

t/f Exposure to macrolide antibiotics (for treatment/ prophylaxis of pertussis) may increase risk.

A

true!

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4
Q

presentation of pyloric stenosis

A

Non-bilious emesis that becomes progressively forceful

Vomiting, intermittent to start

Anxious to feed after emesis
Projectile vomiting as disease progresses

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5
Q

age range for pyloric stenosis

A

Range: Birth- 3 months

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6
Q

complication of pyloric stenosis

A

Dehydration, depending on time to diagnosis

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7
Q

exam findings for pyloric stenosis

A

Anxious, hungry appearing

Dehydrated, malnourished – in advanced disease

Palpable pylorus (described as an “olive”)

Firm, mobile mass, olive shaped and located above and to the right of the umbilicus

Visible gastric peristalsis

Jaundice is commonly present

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8
Q

first line imaging for pyloric stenosis

A

US (Merica!) 95% sensitivity

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9
Q

if you don’t do an US and you do a barium upper GI exam what are you looking for

A

string sign- elongated pyloric channel

shoulder sign- bulge of the pyloric muscle in to the antrum

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10
Q

what lab finding will you see with pyloric stenosis

A

Met B will demonstrate a hypochloremic metabolic alkalosis

due to loss of hydrogen ions and chloride from emesis

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11
Q

how do you manage pyloric stenosis

A

Rehydration/ correction of electrolytes (may present with alkalosis secondary to vomiting)

Surgical consultation

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12
Q

what is celiac disease

A

autoimmune disease

Gluten protein sensitivity

Wheat, barley, rye, less commonly oats

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13
Q

what does celiac disease cause

A

Chronic inflammation of the small intestine

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14
Q

what antibody is present in celiac disease

A

Anti-TG2 antibodies present

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15
Q

what is the classic presentation of celiac disease

A

after the introduction of gluten containing foods:

Chronic diarrhea,
abdominal distention, irritability,
anorexia,
vomiting and poor weight gain

stops with a gluten free diet,

starts with re-introduction of gluten

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16
Q

what is the common (it is atypical) presentation of celiac disease

A

minor GI issues

low height and weight increase

anemia from iron deficiency (not responsive to iron sups) (teeners)

arthritis, bone issues

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17
Q

celiac disease PE findings

A

Bloating of the abdomen

Dental enamel hypoplasia – rare but highly specific when present

Muscle wasting

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18
Q

lab findings for celiac disease

A

IgA anti-TG2

D-AGA

steatorrhea

Hypoproteinemia

Anemia (low MCV-iron def)

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19
Q

(there is so much about celiac disease wtf!) what do you see on bowel biopsy

A

Villous atrophy with hyperplasia of the crypts
Abnormal surface epithelium

(marsh grading system)

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20
Q

what does the marsh grading system look at

A

Intraepithelial lymphocytes

Crypt hyperplasia

Villi

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21
Q

what is intussusception

A

segment of intestine telescopes into the adjoining intestinal lumen, causing bowel obstruction.

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22
Q

age for intussusception

A

children aged 3 months to 6 years of age

23
Q

where does intussusception occure

A

Usually at ileocecal junction

24
Q

hallmark of intussusception

A

the jelly stool (dont eat it! not smuckers)

Sausage-shaped mass

knees to chest

25
Q

what is the common presentation of intussusception

A

paroxysms of abdominal pain with screaming and drawing up of the knees

Vomiting and diarrhea occur soon after

Bloody bowel movements with mucus appear within next 12 hours

Lethargic between paroxysms and may be febrile

26
Q

Intussusception US findings

x ray findings

A

coil spring

lack of colonic gas

27
Q

intussusception tx

A

Hydrostatic/ pneumatic reduction (barium or h2o)

surgical

28
Q

presents between age 2-8

bright red blood on the stool or protrusion from the rectum

(red thing coming out of the butt hole)

A

Juvenile polyps

tx - endoscopic resection

29
Q

containis all bowel layers

Most common congenital GI abnormality

A

Meckel’s diverticulum

30
Q

what are the rules of twos for Meckel’s diverticulum

A

2:1 Male/ Female ratio,

usually within 2 feet of terminal ileum,

up to 2 inches in length

31
Q

Meckel’s diverticulum findings

A

stool is brick colored or currant jelly colored

obstruction if persistent

an be the lead point for intussusception

32
Q

imaging for Meckel’s diverticulum

A

Nuclear imaging – Meckel radionuclide scan

tx - surgical removal

33
Q

Most common indication for acute abdomen surgery in children

Incidence of perforation is high in childhood, particularly in children <2 y.o.

A

Appendicitis

34
Q

signs of Appendicitis

A

Anorexia

Vomiting

Pain – usually periumbilical to RLQ

Diarrhea

35
Q

when does perf typically happen

A

36 hrs after symptom onset

36
Q

imaging used for appendicitis

A

US

CT

37
Q

appendicitis UA findings

cbc findings

A

few white or red blood cells

Elevated white count
CRP can be elevated

38
Q

t/f preme’s have a lower chance of hernia formation

A

false

males also have a higher risk

39
Q

age with highest risk of Incarceration (jail time baby criminal!)

A

under 1yo

40
Q

when to refer a hernia

A

History of mass/ reducible mass: Elective referral

Reducible mass w/ secondary symptoms: Urgent referral

Non-reducible mass: Emergent referral

41
Q

what is constipation (this is getting deep)

A

“Any definition of constipation is relative and depends on stool consistency, stool frequency, and difficulty in passing the stool.”

42
Q

what is normal for stools
newborn:

breast feed:

formula feed:

toddler:

preschool:

A

Newborn: usually 4 soft or liquid stools

Breastfed: 3 soft/day

Formula fed: 2 -3 stools/day

Toddler: 1-2 formed stools/day

Preschool: 1-2 formed stools/day

43
Q

common times for constipation to occur

infancy:

toddler:

school age:

A

Infancy: at transition to solid foods

Toddler: at transition to toilet training

School-age: at entry to school

44
Q

ddx for constipation

A

Cystic Fibrosis – meconium plug

Hirschprung – failure to pass stool, or passage of only small amount

Hypothyroidism

45
Q

tx for constipation infants

A

Add osmotically active carbohydrates to the formula, titrating to desired effect (soft, easy to pass stool)

fiber

glycerin suppositories for impaction

46
Q

t/f Toilet training may trigger constipation

A

true very true

47
Q

tx for toddler constipation

A

decrease milk

increase fiber

miralax

mineral oil

laxatives / softners

48
Q

cause of constipation for school age

A

stool with holding

tx is same as toddler

49
Q

Voluntary or involuntary passage of feces into inappropriate places at least once a month for 3 consecutive months once a chronologic or developmental age of 4 has been reached”

A

encopresis (ooops i crapped my pants!)

50
Q

signs of encopresis

A

large stools that clog toilet

dirty underpants

history of uti

51
Q

rectal exam findings in encopresis

x ray findings

A

hard stool in vault

lots of poop

52
Q

encopresis tx

A

mineral oil or lax

bowel training

53
Q

gi issues that have butt hole bleeding

A

intussuscepton
juvenile polyps
meckel’s diverticulum

peds special pops (8 decks)

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